Development and validation of a dynamic prognostic score for hepatitis B virus–related acute-on-chronic liver failure

ObjectiveHepatitis B virus-related acute-on-chronic liver failure is a rapidly progressive syndrome associated with high mortality. The aim of this study was to develop a dynamic prognostic score for precise outcome prediction in patients with hepatitis B virus-related acute-on-chronic liver failure.MethodsData from a single-center retrospective cohort were used to develop a dynamic prognostic score. The score was subsequently validated in an external multicenter prospective cohort.ResultsA total of 124 patients with hepatitis B virus-related acute-on-chronic liver failure were included in the derivation cohort. The change in the delta Chinese Severe Hepatitis B Research Group-acute-on-chronic liver failure II score between day 7 and baseline (δCOSSH-ACLF II 7-0) showed better predictive performance than the baseline Chinese Severe Hepatitis B Research Group-acute-on-chronic liver failure II score. Multivariate Cox regression analysis identified baseline total bilirubin, baseline prothrombin time international normalized ratio, and δCOSSH-ACLF II 7-0 as independent predictors of 90-day survival. We proposed a dynamic prognostic score calculated as follows: Dynamic prognostic score = 0.005 × total bilirubin + 0.609 × prothrombin time international normalized ratio + 1.234 × δCOSSH ACLF II 7-0. The area under the curves of the new score were 0.923 and 0.925 for predicting 28- and 90-day mortality, respectively. These findings were replicated in the validation cohort.ConclusionThe new prognostic score, based on dynamic changes in the clinical course, can accurately predict short-term mortality in patients with hepatitis B virus-elated acute-on-chronic liver failure.